There is no denying that the impacts of COVID-19 are omnipresent in all of our lives right now. At the time of writing this, the death toll has nearly reached 96,000 people and unprecedented public health measures have been initiated around the globe. In Australia, we have rapidly mobilised the healthcare system in the best way we know how to prepare for the forecasted peak to come, but is there more that we could possibly be doing?
It’s Easter weekend, a time for family, friends and celebration. In Victoria, stage 3 restrictions have recently been enforced, outlining only four reasons you can leave the house; medical appointments, food, exercise and travelling to and from work. Gatherings of more then 2 people are strictly prohibited and outdoor gyms and playgrounds have been closed. None of these restrictions are terribly compatible with traditional Australian easter celebrations.
This may seem drastic and in direct opposition to the freedoms we have become so accustomed to. However, when you consider that social distancing and voluntary self isolation are some of the most effective means we know of for helping to mitigate the spread of infection during a pandemic perhaps your perspective starts to change.
Australia are preparing for between 50,000 and 150,000 deaths. No matter how many dedicated health professionals we have fighting the virus, the Australian public has the most important role in preventing deaths. The longer this thing goes on, the more chance our medical system and its resources have of saving lives. We have 100,000 reasons to stay at home and #flattenthecurve.
Despite our public health measures we are still expecting between 5 million and 15 million cases Australia wide. Of these cases, based on what we’ve learned from China, 26% will require a bed in ICU and 17% will require mechanical ventilators.
Our health care system is also doing what it can to make changes, as it prepares for the onslaught that is likely to ensue. We are now in the process of recommissioning purpose-built facilities (closed hospitals) and taking over suitable alternatives such as hotels. This creates extra beds for sick patients and a space for observation and quarantine as diagnosed cases begin to improve. Hospital staff are also undergoing additional training to operate equipment, triage or provide specific patient care.
Among these, are physiotherapists being deployed on the frontline. Their roles include assisting the weaning of patients from ventilation machines, ensuring proper positioning to increase oxygen intake efficiency and help to recondition patients breathing and muscle function following disuse.
This is a fantastic use of highly trained health professionals to help deal with a crisis. The question is, could we be doing more to collaborate and support a health system under strain? Are we utilising all of our available resources?
As more and more allied health clinics across the country begin to close, ensuring they aren’t vectors for the spread of infection, many highly trained health professionals are left under-utilised. Of course, many are using technology to support patients via telehealth, an important means to help reduce the load on the healthcare system. Although for practitioners who are trained to treat people with their hands, is this the best use of their skill sets?
Does osteopathy have a role to play?
Since the late 1800’s, osteopaths have been treating patients with their hands. They treated all kinds of ailments and illnesses, as well as pain and disability. Osteopaths don’t cure, or fight disease, they use manual therapy to treat restrictions in the the musculoskeletal system to help provide an environment that supports the body’s natural tendency towards health.
In the context of a virus like COVID-19, this means treating the ribs to help patients breathe more easily, releasing tight muscles to allow for better local tissue circulation, or using techniques to help boost immune responses.
This isn’t a new concept, with osteopathy playing a role in pandemics of the past. During the Spanish flu, it was estimated that the death rate was 40 times lower with osteopathic care when compared with only conventional medical treatment. Although the figures are impressive, no doubt there would be shortcomings when evaluated by today’s rigorous standards of research. In addition, osteopaths recording these statistics were osteopathic physicians (DO). In the USA DO’s have full medical practice rights and are licensed to prescribe medications or perform surgery. The difference between traditional medical doctors and a DO is an understanding of osteopathic philosophy and manual therapy. Although in Australia osteopaths do not receive conventional medical training, they are trained extensively in osteopathic philosophy and manual therapy. So where does this leave Australian osteopaths for the COVID-19 Pandemic?
Desperate times call may call for desperate measures. However, it is no time to introduce practitioners who are unfamiliar with hospital protocols to provide hands on treatment with low level evidence of it’s efficacy in this setting. Perhaps in the aftermath of this pandemic we can reflect upon how to greater utilise all of our resources in healthcare to provide the best patient care possible and to reduce strain on the system.
Osteopaths could be used in conjunction with standard medical care in primary medical centres or rural hospitals, where resources are less robust. Osteopathic treatment of elderly populations with pneumonia has shown reduction in IV antibiotic use, length of stay in hospital and mortality. Likewise, osteopaths helped to reduce duration of hospital stay and associated costs in preterm infants and support patient’s recovery following heart surgery.
This of course would require osteopaths to undergo some training in a hospital or general practice setting. Some of which has already taken place at Victoria University and RMIT, where senior students have worked alongside orthopaedic surgeons and physiotherapists in Indian hospitals. Could this training occur outside an orthopedic realm to include other areas of speciality?
It would be a paradigm shift, but we are increasingly finding that multidisciplinary care helps to improve health related outcomes. The unprecedented nature of COVID-19 could be an opportunity to reassess how we can incorporate all our healthcare resources to work together in the future.